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causes of signs > RS Signs > Flashcards

RS Signs Flashcards

1
Q

Pulse

A

Paradoxical- respiratory distress

Bounding- CO2 rention.

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2
Q

Face

A

Ptosis and constricted pupil- horners eg pancoast tumour.
Blue tongue and lips- central cyanosis.
Pale conjunctiva- anaemia.

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3
Q

Tracheal displacement

A

Towards collapse or UNILATERAL fibrosis or lung removal.
Away from large pleural effusion or tension pneumothorax.
Slight R deviation normal.
Cricosternal distance over 3cm- hyperexpansion.
Tracheal tug on inspiration- severe airflow restriction.

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4
Q

Lymphadenopathy

A

CA

TB

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5
Q

Raised JVP

A

Cor pulmonale

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6
Q

Apex beat

A

Impalpable- COPD, pleural effusion, dextrocardia.

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7
Q

Expansion

A 
Under 5cm on deep inspiration abnormal. 
Should be symmetrical.
-unilaterally low-
Pneumonia, pneumothorax, pleural effusion, lobar collapse. 
-bilateral- 
ILD stiffness, hyperinflation.
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8
Q

Percussion

A

Dull- collapse, consolidation, fibrosis, pleural thickening, pleural effusion STONY DULL.
Hyperresonant- pneumothorax or hyperinflation (COPD).

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9
Q

Breath sounds

A
  • Normal vesicular rustling
  • Brochial breathing- harsh with gap between inspiration and expiration. Occurs in firm lung tissue eg consolidation (pneumonia), fibrosis, above a pleural effusion, large pericardial effusion. May have increased vocal resonance too.
  • Diminished breath sounds- pleural effusion, pleural thickening, oneumothorax, bronchial obstruction, asthma, COPD.
  • Silent- life threatening asthma.
  • Wheeze- monophonic if partial obstruction of one airway eg tumour.
    Polyphonic if widespread narrowing of differing calibre eg asthma, COPD. Also LVF cardiac asthma.
    -Crackles/crepitations- caused by re opening during inspiration of small airways occluded during expiration.
    Fine and late in inspiration if coming from distal air spaces eg pulmonary oedema, fibrosing alveolitis.
    Coarse in mid inspiration if proximal eg bronchiectasis.
    In early inspiration if small airways disease eg COPD.
    Late or pan inspiration if alveolar disease.
    -stridor- part obstruction upper airways. Lumen, wall or extrinsic.
  • Pleural rubs- inflammatory exudate roughens pleural surfaces eg pneumonia, pulmonary infarction.
  • loud clear vocal resonance if consolidation (brochial breathing).
    Decreased vocal resonance if pneumothorax, pleural effusion.
    Normal is muffled.
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10
Q

Hyperventilation- fast or deep.

Can lead to respiratory alkalosis and hence parasthesia.

A

Main cause in anxiety.

  • kussmaul deep sighing in metabolic acidosis eg DM or alphoholic ketoacidosis, renal impairment.
  • neurogenic- pontine lesions.
  • hyperventilation syndrome panic attacks
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11
Q

Cheyne stokes deeper then shallower in cycles

A

brainstem lesions or compression eg RICP, stroke.

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12
Q

Sputum

A
  • black carbon specks- smoking.
  • yellow or green- infection eg bronchiectasis, pneumonia.
  • pink frothy- pulmonary oedema.
  • haemoptysis- malignancy, TB, infection, trauma.
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13
Q

Deformities

A
  • barrell chest AP diameter, reduced expansion, tracheal descent- chronic hyperinflation eg COPD, asthma.
  • pectus carinatum sternal prominence - lung hyperinflation while thorax still developing eg chronic childhood asthma.
  • pectus exacavatum lower sternal depression- developmental defect. Associated with scoliosis, marfans and ehlers. Can cause heart displacement and reduced capacity.
  • kyphosis increased AP T spine curvature.
  • scoliosis- lateral curvature.
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14
Q

Stridor inspiration

A

Partial obstruction upper airways.
In lumen eg FB, tumour, VC palsy.
In wall eg oedema, laryngospasm, tumour, croup, epiglittitis, amyloidosis.
Extrinsic eg goitre, oesophagus, lymphadenopathy, post op.

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15
Q

Cough

A
  • loud brassy- pressure on trachea eg tumour.
  • hollow bovine- RLN palsy.
  • barking- croup.
  • chronic- pertissis, TB, FB, asthma.
  • dry chronic- oesophageal reflux, ACEi.
  • painful
  • throat clearing
    Under 3 weeks- RTI
    Over 3 weeks- COPD, asthma, CA, meds eg ACEi
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16
Q

Haemoptysis

Frothy, alkaline, bright red

A
  • infective- TB, brochiectasis, pneumonia, abcess, COPD, fungus, virus (pneumonitis, hep, HIV), helminth, bronchitis.
    -pulmonary oedema-frothy pink.
  • neoplastic- primary or secondary
  • vascular- PE, vasculitis, HHT, AVM, capillaritis.
  • parenchymal- fibrosis, sarcoidosis, haemosiderosis, CF.
  • pulmonary HTN- idiopathic, TE, cyanotic CHD, fibrosis, bronchiesctasis.
  • caogulopathy- thrombocytopenia, warfarin.
  • trauma or FB- post intubation, eroding defib.
    Find out how much
    Differentiate from haematemesis.
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17
Q

Dyspnoea-

Awareness that abnormal effort to breathe

A
  • lung
  • cardiac- IHD, LVF, MV stenosis.
  • anatomical- chest wall, muscle or pleura disease. Ascites.
  • other- shock, anaemia, respiratory acidosis.
    ACUTE- FB, pneumothorax, PE, acute pulmonary oedema.
    SUBACUTE- asthma, parenchymal disease eg alveolitis pneumonia.
    CHRONIC- COPD, HF, anaemia.
    Signs- accessory muscle, tracheal tug, nasal flaring, sternal retraction, intercostal recession, tripoding.
    -Qs- onset duration, how long for, how much exercise, previous heart/lung issues, fever, smoke, pain.
    -differentials- unfit, infection, efffusion, COPD, asthma.
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18
Q

General inspection

A 
COINS
Chest drain
O
Inhalers
News
Sputum pot
Breathing, accessory muscles, colour etc.
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19
Q

Horners

A 
T1 lesion due to pancoast tumour (brochial carcinoma) in lung apex compressing sympathetic chain. 
Intrinsic muscle wasting
Ptosis
Anhydrosis
Mitosis
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20
Q

Pleural effusion signs

A 
Reduced expansion
Stony dull percussion
Reduced air entry
Reduced vocal resonance
Veiscaular breath sounds, reduced intensity on affected side. 
Tracheal deviation away if large
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21
Q

Consolidation signs
Consolidation- fluid inside alveoli
Effusion- fluid in pleural space

A

Reduced expansion
Dull percussion
Increased vocal resonance
Bronchial breathing, possible coarse crackles.

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22
Q

Collapse signs

Due ot large airway obstruction eg CA

A 
Reduced expansion on affected side 
Dull or normal percussion
Reduced breath sounds on affected side 
Trachea deviation towards
Reduced vocal resonance
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23
Q

Pneumothorax signs

A

Reduced expansion
Hyperresonance
Reduced breath sounds, cab be absent in tension
Trachea deviated away from tension pneumothorax
Reduced vocal resonance

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24
Q

Fibrosis signs

A 
Reduced expansion on affected side(s)
Dull or normal percussion
Fine inspiratory crackles
Trachea pulled towards unless bilateral fibrosis. 
Vesicular breath sounds 
Normal or increaed vocal resonance
FEV1/FVC normal but FVC very low
Low diffusion capacity
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25
Q

Cause of exudative effusion

A

Inflammation
Infection
??

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26
Q

Causes of transudative effusion

A

HF

??

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27
Q

Virchows triad

A

Vessel wall
Blood components
Blood flow

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28
Q

HF vs DVT

A

DVT unilateral
HF- pitting oedema and bilateral and worse through day.
DVT- pain, red, hot, tender

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29
Q

Horners syndrome

A

Triad- miosis (pupil constriction), partial ptosis, ipsilateral anhidrosis (lack sweat).
Interrupted face SNS supply eg at throacic outlet (pancoast tumour). Or brainstem, SC, ICA hitchhike.

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30
Q

Pancoast syndrome

A

Apical lung CA invades SNS plexus in neck.

Can= ipsilateral horners, brachial plexus lesion, RLN lesion.

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31
Q

Sarcoidosis

A

Multisystem non caseating granulomtous disorder. Unknown cause. Afro carribean and asian.
Usually asymptomatic, can get cough or rash. Acute= erythema nodosum.
Lungs- pulmonary lymphadenopathy and infiltration/fibrosis.
Other- lymphadenopathy, hepatomegaly, splenomagaly, conjunctivitis, glaucoma, bone cyst, bell splasy, meningitis, SOL, renal stones, pituitary dysfunction.
Tx- rest and NSAIDs. Occasionally steroids or methotrexate.
Differentials- lymphoma, TB.

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32
Q

Stridor

A

Luminal- FB, tumour, VC palsy
In wall- anaphylaxis oedema, laryngospasm, tumour, croup, epgilottitis, amyloidosis.
Extrinsic- goitre, oesophagus, LN, post op.

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33
Q

Type 2 respiratory depression causes

A
  • respiratory depression- head injury, drugs.
  • muscle weakness- SC injury, peripheral neuropathy, NMJ, myopathy.
  • chest wall problems- obesity.
  • lungs difficult to ventilate- late acute asthma, COPD, fibrosis.
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34
Q

Type 1 respiratory failure causes

V/Q mismatch (hyperventilation cannot increase O content)

A
  • early acute asthma- V/Q mismatch.
  • PE- V/Q mismatch.
  • fibrosing alveolitis- increase diffusion distance. Affects O more as lower solubility.
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35
Q

Central cyanosis oral mucosa or tongue

A

Arterial sats under 90%

PO2 8kPa

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36
Q

Hyperinflation

A

More than 6 anterior ribs seen.
Flat hemidiaphragms.
Ribs more horizontal.
Normally in full inspiration diaphragm crosses 6th rib anteriorly.

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37
Q

T1 respiratory failure- low arterial O, normal/low CO2 as hypoxia stimulated RR

A

Mechanism-
Poor diffusion across alveoli-
-fibrosis increase distance
-emphysema decrease sa
V/Q mismatch
-reduced ventilation to part of lung (V/Q under 1)- pneumonia, acute severe asthma, RDS.
-reduced perfusion of part of lung (V/Q under 1)- PE.

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38
Q

T2 respiratory failure- low O AND high CO2

A

Mechanism-
Ventilation pump failure- hypoventilation.
Causes of T2 failure-
-primary muscle disorder- myopathy, MND
-chest walls problems-obesity, kyphoscoliosis, flail segment
-poor lung compliance- fibrosis.
-high airway resistance- severe acute asthma, late COPD.
Other causes hypoventilation-
-brainstem respiratory depression- head injury, opiates.
-SC trauma
-phrenic and ICN- guillain barre
-NMJ-MG
-pleural cavity- pneumothorax, large pleural effusion.
-upper airway obstruction- laryngeal oedema, FB.
Acute effects-
SOB
Acidosis
Usually requires assisted ventilation

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39
Q

PE consequences

A

T1 respiratory failure
RHF
Reduced CO

40
Q

Hypoxia

A 
-Causes:
Respiratory failure causes
Low inspired O
R to L shunts
-clinical features:
Excercise intolerance
Tachypnoea
Confusion
Central cyanosis when sats under 85%
-chronic=
Increase Hb
Increase 23DPG
Hypoxic vasoconstriction pulmonary arterioles= pulmonary HTN, RHF.
41
Q

URT flora

A 
-Common-
Strep viridans
Neiseria sp
Anaerobes 
Candida 
-less common
Strep pneumoniae and pyogenes 
H influenzae
Pseudomonas 
Ecoli
42
Q

CAP

A

Organisms- strep pneumoniae, H influenzae, moraxella catarrhalis.
Tx- likely pneumococcal so pen.
Mild to moderate give amoxicillin OR doxycycline.
Moderate to severe give co amoxiclav AND doxycycline.

43
Q

Pneumonia general

A

Symptoms- SOB, cough maybe yellow or rusty sputum, fever, rigors, pleuritic pain, malaise, nausea, vomiting.
Signs- pyrexia, tachyc/p, cyanosis, dull, bronchial breathing, crackles.
Investigation- all bloods, CXR, swabs and cultures, biopsy, BAL, serum Ab.
Tx- fluid, O, analgesia, antipyretic, AB.
Outcome- resolution scarring, abcess, bronchiestasis, empyema.

44
Q

Atypical pneumonia

A

Legionella
Mycoplasma
Chlamydia

45
Q

CURB score

A 
Confusion
Urea over 7
RR over 30
BP under 90/60
Score of 2 consider admission.
2-5 means severe, admit.
46
Q

Viral pneumonia

A

Influenza
Parainfluenza
RSV
Adenovirus

47
Q

HAP

A 
Sa
Pseudomonas
H influenzae
Enterobacteria 
Tx- co amoxiclav as more gram negs
48
Q

Aspiration pneumonia

A

Strep viridans
Anaerobes
Tx- co amoxiclav.

49
Q

Immunosuppressed pneumonia

A

PCP
Aspergillus
CMV

50
Q

TB pathogenesis

A

Inhaled aerosol
Alveolar macrophage engulf
Local LNs= primary complex (ghons focus+draining LN)
Then either progression to active PRIMARY disease OR initial containment then latent infection then cure or POST PRIMARY TB.

51
Q

Granuloma

A

Core caseous necrosis
Epitheloid macrophage
Multi nucleated langhans giant cells
Lymphocytes

52
Q

Latent TB-inactive, contained

A

Reactivation eg age, malnutrition, HIV, immunosuppresion, steroids, substance abuse, lymphoma, DM.
Gives positive tuberculin skin test- TIV hypersensitivity to mycobacterial protein. Also positive IFNg.
CXR normal, sputum smear and culture negative, no symptoms, not infectious.

53
Q

Extra pulmonary TB

A 
Larynx
LNs
Pleura
Brain- TB meningitis 
Kidneys to lower UT
Peritoneum
Bones eg spine
Miliary- carried everywhere in blood= headache, pleural/pericardial effusion, ascites, retinal.
54
Q

TB general

A

Hx- travel, ethnicity, immunocompromise, homeless, drug, contacts, BCG
Symptoms- fever, weight loss, malaise, anorexia, night sweats, cough sometimes blood, SOB if pleural effusion.
Signs- fever, weight loss, maybe crackles, CXR caviatation/fibrosis, pleural effusion.
Investigation- CXR (solid or cavitation lesion, streaky fibrosis, calcification, often apex, pleural effusion if bad), sputum 3 early ZN stain and culture and granuloma histology, bronchoscopy, TST, iFNg.

55
Q

TB tx

A 
1st line- 
-rifampicin- CYP induction, increase AST/LT, orange.
-isoniazid- peripheral neuropathy, hepatotoxicity. 
-pyrazinamide- hepatotoxicity.
-ethambutol- visual disturbance. 
Give all for 2/12 then 1st 2 for 4/12.
2nd line- quinolones etc.
Also vit D, surgery. 
Poor compliance.
Contacts.
56
Q

Lung CA RFs

A 
Smoking
Asbestos
Radon
Occupational carcinogens eg nickel, arsenic
Genetic
57
Q

Lung CA staging

A 
T=tumour- size, location in lung, number
N=LNs- hilar, same side, above clavicle
M= mets within chest or outside
Local spread in chest- draining LN, pericardium, pleura, other lung.
Distant- brain, liver, adrenals, bone
58
Q

Lung cancer S+S

A

-Symptoms-
Primary tumour- NONE, cough, SOB, wheeze, haemoptysis, infections, pain, weight loss, malaise.
Regional mets- bloated face SVC obstruction, hoarse voice, dysphagia, CP
Distant mets- bone pain or fractures, CNS eg heache, vision, confusion.
Metabolic- thirst and constipation if hyperCa, seizure if hypoNa.
-signs-
Clubbing
Cachexia
Dysphagia
Pale conjunctiva
Cervical lymphadenopathy
Horners, hoarse voice, lower brachial plexus.
Consolidation
Persistent pneumonia
Partial obstruction- monophonic wheeze, stridor, infection distal to tumour. Complete bronchi obstruction- distal collapse.
Pleural effusion
Muffled heart sounds
Hepatomegaly
Skin mets
Neuro long tract signs
NONE

59
Q

Lung CA types

A 
Carcinoma= invasive malignant epithelial tumour
-non small cell-
Squamous cell carcinoma 40%
Adenocarcinoma 35%
Large cell carcinoma 5%
-small cell carcinoma- 12%
-rare eg carcinoid- 5%
60
Q

Lung CA investigation

A

-Molecular markers:
EGFR mutation
KRAS mutation
ALK mutation
PD1 mutation
-bronchoscopy, biopsy, imaging, pleural fluid analysis, other mets tests, FBC, CRP, blood serology, sputum culture, lung function.
-pleural fluid- protein, microscopy, cytology (CA).

61
Q

Lung CA performance status

A 
0- no symptoms, normal activities.
1- symptoms but normal ADLs.
2- symptoms and bed/chair under half day.
3- symptoms and bed/chair over half day.
4- bedridden
5-dead
Radical tx requires 2+
62
Q

Lung CA tx

A 
Surgery- mostly non small cell.
Radiotherapy- radical or palliative.
Combination chemo- small or non small cell, neo or adjuvant. 
Combination therapy- chemo+ radio.
Biological- based on mutation.
Palliative
63
Q

Pack years

A

Number of packs per day (20 a pack) x number of years smoked

64
Q

CXR

A

Normal anterior 5th-7th rib MCL.
Silhouette sign for seeing consolidation.
Lingula= part of L upper lobe.
Mediastinal push- pleural effusion, tension pneumothorax.
Pull- fibrosis, collapse, previous surgery.
Cardiac index normal over 50% on PA. AP exaggerates heart size.
DR ABCDE
D- details/demographics
R- RIPE (rotation, inspiration, penetration, everything visible that should be?).
A-airway
B-breathing (lung zones)
C-circulation/central (mediastinum and heart)
D-diaphragm
E-everything else eg bone soft tissue

65
Q

Pneumothorax CXR

A

Large if over 2cm bewteen inner chest wall and lung.
Mediastinal push.
Can be spontaneous, secondary to eg CA or COPD, iatrogenic eg central line.
Tx- aspiration or chest drain. Chemical pleurodesis. Pleurectomy. O.
Tension- tachyc, hypotension, reduced expansion, hyper resonance, mediastinal push, hypoxaemia.

66
Q

Pleural effusion CXR

A 
Fluid in pleural space. 
White uniform.
Loss costophrenic angle. 
Hemidiaphragm obscured. 
Meniscus
Tracheal push
67
Q

Lobar collapse CXR

A

Elevated hemidiaphragm ipsilaterally and rib crowding.
Mediastinal pull.
Pulmonary vessel crowding.
VAIL L upper lobe.
SAIL L lower lobe. Complete occlusion lower lobe bronchus.
Whole lung collapse- homogenous opacification entire side and tracheal pull.

68
Q

Consolidation CXR

A

Pus/blood/fluid/cell to alveoli.

Dense opacification.

69
Q

ILD S+S

A

Symptoms-
SOB chronic onset, decrease exercise tolerance, dry cough.
Signs-
Tachypnoea, bilateral reduced expansion, coarse crackles, cyanosis, RHF signs, clubbing in cryptogenic fibrosing alveolitis.

70
Q

ILD types

A

Occupational- asbestosis, silicosis, coal pneumoconiosis.
Tx- radiation, methotrexate, amiodarone, nitrofurantoin, chemo, bleomycin.
CT disease- RA, SLE, scleroderma.
Immunological- sarcoidosis, hypersensitivity pneumonitis.
Idiopathic- cryptogenic fibrosing alveolitis, idiopathic pulmonary fibrosis.

71
Q

ILD fibrosing alveolitis

A

Infection or pollution trigger alveolar mac then cascade.
ROS and protease damage.
Small nodules, lower lobes, fine crackles.
Tx- oral steroid, monitor LFTs.

72
Q

ILD extrinsic allergic alveolitis

A

Inhalation organic matter=allergic reaction in small airway and alveolar walls.
Acute eg farmers lung actinomycetes. Diffuse nodules hila.
Chronic eg bird fancier. Upper fibrosis.

73
Q

ILD idiopathic pulmonary fibrosis

A

Median survival 3 years

New mAb therapies.

74
Q

Asbestos

A 
Plaques
Diffuse pleural thickening 
Benign asbestos pleural effusion
Asebstosis
Mesothelioma
Bronchogenic lung CA
Rounded atelectasis
75
Q

Pleura

A

-pleural space function-
Allow movement of lung against wall
Couple movement of lung and wall
Pleural fluid circulation- 15ml per day made by parietal pleura capillary filtration, absorbed by parietal lymphatic stomata.
-innervation
Parietal phrenic and ICN so pleuritic pain sharp and worse on inspiration.
Visceral no somatic
-pleuritic pain
Can be anywhere in chest, sharp, worse on inspiration or cough, may have secondary symptoms.
Causes- lobar pneumonia, PE, infarction, pneumothorax.

76
Q

Pleural fluid accumulation

A

Increase pulmonary intravascular pressure eg HF.
Decrease plasma oncotic pressure eg liver fail.
Increase capillary permeability eg inflammation or CA.
Lymphatic obstruction.

77
Q

Trans and exudate

A

Exudate of high protein and LDH.
Get fluid by thoracocentesis- test appearance, cell count and differentiation, protein, LDH, pH, glucose, cytology.
-transudate- HF, nephrotic syndrome, cirrhosis, hypoalbumin.
-exudate- infection, malignancy, RA, PE, pancreatitis.
-empyema- infection. low pH, low glucose. Get adhesions and loculations.
-haemothorax- trauma, iatrogenic.
-chylothorax- milky. Lymphatic interruption, lymphoma, iatrogenic, trauma.

78
Q

Pleural CA

A

Mets- lung, breast, kidney, colon.

Primary- mesothelioma. Dull diffuse CP, often effusion.

79
Q

Airway obstruction

A

Monophonic wheeze
Pneumonia distally
Collapse if complete obstruction

80
Q

Pneumonia CXR

A

Patchy opacification, often upper lobe.

81
Q

TB CXR

A

Patch opacification often both upper zones
Horizontal fissure appears high
Cavities

82
Q

Solitary hilar mass CXR

A

CA
Infection
Benign tumour
CT disease eg RA

83
Q

Pulmonary oedema CXR

A

Bilateral ill defined peri hilar shadowing- bat wings

Cardiac enlargement

84
Q

MRC dyspnoea scale

A

1-SOB on strenuous exercise
2-SOB when hurrying on level or slight hill.
3-walk slower or has to stop
4-stop after 100yards or few mins on level.
5-cant leave house.

85
Q

Wheeze expiration

A

Asthma
COPD
FB

86
Q

Hoarse voice

A

Transient inflammation vocal cords
Vocal cord tumour
RLN palsy- L side long course, can be damaged by bronchial carcinoma.

87
Q

Drug hx

A

ACEi cough
beta blocker wheeze
Oestrogens PE
Amiodarone fibrosis

88
Q

Social hx

A

Smoking
Occupation
ADLs, stairs at home

89
Q

Intrinsic hand muscle wasting

A

T1 root compression by peripheral lung tumour eg pancoast

90
Q

COPD or asthma signs

A

Barrel chest
Reduced expansion as hyperinflated
Resonant percussion, hyper resonant over bullae, liver lower
Vesicular breath sounds with prolonged expiration and wheeze

91
Q

Pleura surface markings (costal cartilages)

A

-apex extends 3 cm above medial 1/3 of clavicle, into root of neck. Apical pleura covered by fascia (subpleural membrane) which is attached to inner border of 1st rib.
-then pleura meet at 2nd CC
(2nd CC articulates with sternum at sternal angle)
-Then down to 4th CC
-then L pleura deviates laterally to edge of sternum then down to 6th CC. R pleura just goes straight down to 6th CC.
-then both sides turn laterally, crossing 8th rib at mid clavicular line.
-cross 10th rib at mid axillary and 12th in scapular line.
-to the lateral edge of paravertebral muscles and vertically up to apex.

92
Q

Lung surface markings (ribs)

A

Lower border 2 ribs higher than pleural.= costodiaphragmatic recess.

  • so crosses 6th rib at mid clavicular line, 8th at mid axillary, 10th scapular line and lateral paravertebral muscles.
  • cardiac notch curves further laterally than pleura- from 4th CC to 5th ICS just medial to mid clavicular line.
93
Q

Lung fissures

A
  • L oblique fissure separates upper and lower lobes.
  • R horizontal separates upper and middle. Oblique separates middle and lower.
  • oblique fissure on each side extends from T2 process posteriorly to 6th CC anteriorly.
  • horizontal fissure on R extends from mid axillary, anteriorly along 4th rib.
94
Q

Diaphragm

A

Right dome at 5th rib.

Left dome lower at 5th ICS.

95
Q

Precussion and surface markings

A

Dull below 5th rib due to:
-liver as is only overlapped by very thin lung.
-costodipahragmatic recess.
Resonance below 5th rib is sign of hyper inflation eg COPD.

causes of signs (13 decks)

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